Partnership for Quality Education PQE Collaborative Interprofessional Team Education Initiative CITE

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Partnership for Quality Education
(PQE)Collaborative Interprofessional Team
Education Initiative (CITE)

• Carol Savrin, DNP, CPNP, APRN,BC
• Shirley Moore, PhD, RN, FAAN

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Study Purpose and Design

• The project was designed to create, implement and
  evaluate a model educational experience in which
  trainees (pediatric residents, nurse practitioner
  students, and pharmacy residents) faculty and
  staff learn to work as part of an
  interprofessional team to assess and improve the
  care and outcomes of children.

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Catalyst for Kids Intervention

• Process Improvement/CQI
• Trainees learn in an interprofessional team to
  implement collaborative process improvements
• Teamwork-in-Action
• - Provide efficient interprofessional
  collaborative care to appropriate patients in an
  efficient and effective manner using visit-based
  team care

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Design

• The morning clinics were used as control clinics,
  functioning as usual
• Afternoon clinics were the experimental clinics,
  with the interprofessional teams and
  collaborative care being practiced
• The project was phased in beginning with the
  Monday clinics and then moving to the clinics in
  the rest of the week.

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Teamwork in Action

• Interprofessional, collaborative team meets at
  noon prior to clinics and the project is
  discussed
• Providing efficient interprofessional
  collaborative care to appropriate patients in an
  efficient and effective manner
• Teamwork taught and supported by trained
  facilitator
• Teamwork as an interprofessional team to chose,
  create, and implement collaborative process
  improvement projects
• Didactic training in teamwork and process
  improvement done in three half day workshops over
  a 9-month period

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Teamwork In Action

• At-risk patients are identified
• The Nurse Practitioner student and Medical
  Resident simultaneously see the patient. One
  doing the history while the other performs the
  exam
• The Pharmacy Resident meanwhile assesses the
  patients current medications
• All share their findings and collaboratively
  determine a comprehensive

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Teamwork In Action
No
Sees patient
Yes
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Barriers

• Old habits die hard
• Most faculty preceptors need to be trained in
  these new competencies along with the trainees
• Current documentation systems dont support the
  documentation of group decisions
• Juggling the workload

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Enhancers

• Attention to the logistics
• coordination of schedules, dedicated
• space, structured agendas, incentives
• Clear curriculum addressing
• goals
• skills
• knowledge
• attitudes

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Results

• Determine the effectiveness of the Catalyst for
  Kids Model on trainees attitudes and knowledge
  of teamwork
• A two-group pretest-posttest design
• to measure the impact on teamwork
  
• Variables
• interdisciplinary collaboration
• appropriate use of authority in teams
• attitudes toward teamwork
• knowledge of teamwork skills

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Participants

• 20 health professions trainees (13 pediatric
  residents 5 advanced practice nursing students
  2 pharmacy residents)
• Practicing in 10 primary care pediatric clinics
  (5 control 5 intervention)
• Clinics were conveniently assigned to study
  groups
• 13 participants in intervention group 7 in
  control group
• 13 women 7 men
• Mean age 29 yrs (range 21-39)

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Measures

• Interdisciplinary Collaboration 6 items
• Use of Authority in Teamwork 4 items
• Attitudes toward Teamwork 10 items
• Knowledge of ID Teamwork Skills 17 items
• Analysis of Covariance (ANCOVA) was used to test
  for group differences at completion of the
  program controlling for pretest scores

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Findings

• Significant differences were found between
  residents and nursing students attitudes toward
  teamwork at T1 (nursing students had more
  positive attitudes toward teamwork) no
  differences at T2
• There was minimal inverse relationship of age to
  team skills of age related to team skills

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Results
Lower scores are better
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Results of ANCOVA
Lower scores are better
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Outcomes Measures

• In 2000 the MHMC Pediatric Primary Care practice
  treated 7515 pts of which 7197 encounters in the
  ED (11)
• 1431 (20) of these were for asthma related
  concerns
• If we improve asthma care pts and families will
  be happier, there will be fewer ED visits for
  asthma, and we can stretch resources further

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Outcomes Measures

• Asthma ED visits were tracked for each clinic for
  2 years a year before and a year after the
  intervention
• AM clinics were the control clinics
• PM clinics were the experimental clinics
• An index of ED visits per pediatric asthma
  patient was compiled for each clinic each study
  year

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Asthma ED Visits
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Results

• In four of the five clinics, there was a greater
  drop in the number of ED visits in the
  experimental group than the control group from
  the year prior to the intervention to the year
  following the intervention.
• The Monday PM experimental clinic had the most
  dramatic decrease in ED visits compared to the
  control clinic (Monday AM clinic). This is
  interesting in that the Monday afternoon clinic
  had a longer exposure to the intervention (had
  served as a pilot group).

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Conclusions

• Catalyst for Kids model shows promise an as
  effective training program to enhance knowledge
  of teamwork skills and use of authority in
  teamwork
• Our findings show that team care has a positive
  effect on pediatric asthma visits in the primary
  care setting